Unfortunately the only vet neurologist is in Helsinki. At this point I wouldn't put him through a train journey there (10hrs there and back) unless it would really make a difference. Sammy's regular vet who I saw today is also an eye-specialist and I trust her a lot. When I told her Sammy had a vestibular episode, she was able to reply right away 'that's not a vestibular episode'. She used a device to look within the eyes and was able to describe with a good degree of certainty what she was seeing (which was actually different in each eye) and what causes it in the brain. The thing that isn't clear is what caused the brain damage in the first place and whether it can repair itself. Her theories were stroke, tumor, toxicity as a result of liver failure, or most likely fluid related to SM (in which case relieving the pressure may provide a lot of relief).
The frusimide is for the heart, as she estimated his murmur as grade 4 now. Much louder than last spring. He hasn't had symptoms though - no coughing, exercises happily.
If Sammy is not showing any symptoms of heart disease, then he shouldn't be on any medication for it - if given too early, heart medication can actually do harm - especially frusemide, which according to latest research can possibly damage the heart if given before it is actually needed (which is usually when the heart is causing build up of fluid, which isn't happening yet with Sammy); this is why most neurologists will no longer prescribe it for CM/SM, preferring cimetadine or omeprazole. Long term use of any of the diuretics can harm the liver and kidneys, so getting Sammy off frusemide and on to one of the gentler drugs might actually help. Frusemide is great, of course, when heart symptoms actually appear.
The present drowsiness could be the higher dose of gabapentin, since this is a very common side effect and should wear off in a week or so.
The eye problem could well be a symptom of CM/SM. Both my Cavaliers have got dilated ventricles (Oliver's more severe than Aled's) and the pressure this creates behind the eyes can cause light phobia. They also both have other eye problems - Oliver has dry eye, and Aled has another form of keratosis, where his tears are not good enough quality to keep the eye healthy. I presume your vet has done a test for dry eye, though it might be worth seeing an ophthalmologist (my vet didn't pick up Aled's eye problem because it needed technical equipment).
Getting the medication right seems to take over your life - I sometimes feel as if I am running an eye clinic, a neurology clinic, a clinic for the elderly (Oliver is 12), and a pharmacy! I do hope you can sort out the right mix for Sammy.
Kate, Oliver and Aled
My vet is an eye specialist and was able to tell me today that his eye issue is a result of centralized brain damage rather than a localized issue or even a peripheral vestibular problem. He has other very distressing symptoms which developed very suddenly on Saturday - much as though he had a stroke. I'm just waiting now to see if he will get better or worse.
The gabapentin has acted like a sleeping pill. Perhaps it's a good thing at the moment, since he might otherwise be under stress.
I just don't know about the heart. The vet thought it was enlarged enough and the murmur was loud enough to warrant treatment. He hasn't been on treatment before due to lack of symptoms. For now, I'm going to follow her instructions, since it may also relieve fluid around the brain and the liver.
Thanks for your answer! I'm still hoping for the best, but I do need to face that he is a very ill little dog. Writing here and reading others' experiences seems to help me cope.
This is turning into a dog blog!
After hardly moving from his bed all day, Sammy started playing happily last night with an empty food carton. He's also very happy when he hears me preparing to go out, though he is quite slow and wobbly and apparently would like to spend all his time sniffing the same spot. He still loves his food and was really excited when a friend came over. For those reasons I'm glad I still brought him home. Worrying signs are that he is still shaking his head a lot, his head is still pulling down to one side, and there are signs that he doesn't quite know where sounds are coming from (he hears them immediately but will look in the wrong direction).
About the furosemide: I just remembered the vet mentioning the need to bring down his blood pressure (which is also linked to brain problems like stroke) when she was writing the prescription. Is this something that may need treated even if symptoms like coughing aren't present? To be honest I don't think she actually took his blood pressure (unless she did it when I wasn't there), but at this point I'm happy to try anything that might reduce tension in the brain.
It must have warmed your heart to see him playing. I guess it's just day by day with Sammy now as you don't really know what's going on with him. I'm so sorry that the prednisone probably damaged his liver. Riley's been lucky in that respect as she's been on it now for over six years. You can only hope that maybe time will be a great healer. No matter what, Sammy knows he's loved and you are giving each other something you'll always remember. Hoping for more positive posts!!!
Thanks! Sammy is currently sitting beside me on the sofa staring me down while I eat my pizza, waiting for a crumb to drop. He also did his usual little twirl jump when I gave him his own food. I think he might be feeling better... :) His left eye is more or less back to normal, but I don't think he can see with his right eye and he doesn't like me touching the right side of his face. I just gave him his gabapentin (150mg for now), so he'll probably be back to bed soon.
Tonight will be the first time I give him a tapered down dose of prednisone (2.5mg), so here's hoping it's a good reaction tomorrow and not a bad one...
His recovery still depends on the underlying cause. But I'm happy to have my food steeling sofa buddy back at least for now.
In case anyone else ever goes through this: I found information (below) on a condition called syringobulbia, a progression of syringomyelia, which sounds like it is exactly what Sammy is suffering from. The vet said Sammy's symptoms were related to the brainstem and cranial nerve, as shown by his eye movements and lack of reflex responses around his right eye.
I doubt that the liver is involved and based on what I've read online, I'm beginning to doubt that Sammy's enzyme levels and liver size are even conclusive evidence of liver disease. I'll still reduce the prednisone though, try other combinations and see how he responds.
This occurs if the syrinx extends into the medulla of the brainstem. The cranial nerves become affected:
- Facial sensory loss can occur as the trigeminal nerve becomes involved.
- Vestibulocochlear nerve involvement causes vertigo and nystagmus.
- Facial, palatal and laryngeal nerve palsy can occur as the VIIth, IXth, Xth and XIth cranial nerves become involved.
- Weakness and atrophy of the tongue is caused by XIIth nerve involvement
What's the prognosis for syringobulbia? Can it be kept in check or does it keep progressing? I looked on-line but couldn't find much.
Nearly everything I found on it was for humans and involved immediate surgery. With surgery a percentage nevertheless are eventually wheelchaired. One site mentioned that it is associated with a rapid curve progression. I did find a research article reporting on a case study from the late 1800s when surgery wasn't performed. The woman became gradually incapacitated over 7 years as more of the cranial nerves were damaged. It is apparently quite a rare progression of the disease and associated with cm.
I couldn't bring myself to lower Sammy's prednisone afterall. He started having a flare up of symptoms that sometimes happens late evening while his dose is due. He looked disorientated and started trying to scratch but not being able to balance to do so. I couldn't stand the idea of him being in anymore pain. I'll try again when he is on a higher dose of gabapentin (he is now on 450mg per day and I'm building up). The other option is to hope his liver function is not as bad as suspected and continue to give him both.
I made the decision last night to take him to the vet to be put to sleep. I cried all night, having no idea how I could possibly bring myself to make the call and take him there. Sammy has meant the world to me and he is still only 7 years old. Then this morning he scratched the door to go pee and I noticed that his head tilt was a bit better and he is walking well. I unmade my decision again. This is torture. I'm still thinking maybe he will just get better, but then I terrified that he will suddenly be in distress and there will be nothing I can do for him. I'm on an autumn teaching break this week. I can't imagine dealing with this while I'm working.
ohhhh i am really sorry Laura :((